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Family Health Magazine
DIABETES

Over-the-Counter Medications
Are they safe for people with diabetes?

Mrs. Green comes to the pharmacy counter with a package of cold medication in each hand and a confused look on her face. She has been reading labels but cannot find a medication for her husband, who has diabetes and is home in bed with the flu.

“…not recommended for use by people with high blood pressure, diabetes, or glaucoma without a doctor’s supervision….” “Consult your doctor before taking if you have diabetes….”
These warnings are often found on the packaging of non-prescription or over-the-counter (OTC) medications. Such cautions are often related to the potential for drug interaction. Medications can react with other drugs, food, beverages, or existing medical conditions.

Such interactions can elevate or reduce the amount of drug in the body, increase the risk of side effects, and may even be life-threatening. Eating grapefruit with some medications used to treat high cholesterol can make the level of drug in your body higher. Using certain medications to ease a stuffy nose could raise blood glucose.
Many people with diabetes also have other chronic problems, such as high blood pressure, high cholesterol, nerve pain (neuropathy), and depression. Since several chronic conditions are being managed at the same time, a drug interaction is possible. However, educating yourself can reduce your risk of experiencing harmful drug interactions and side effects. Your pharmacist is a medication expert who is also available to answer any of your questions.

Remember that, in general, ‘sick days’ are associated with changing blood glucose levels. This could be related to the stress of being sick or changes in diet. Following these tips when feeling ill may help.

• Monitor your blood glucose more often when you are sick.
• If blood glucose levels are above 14 mmol/L, check for ketones. If ketones are moderate to large, get medical help.
• Keep taking your insulin, and drink plenty of fluids.
• If possible, eat easy-to-digest foods, in smaller quantities, more often. Bananas, rice, toast and soup are all good choices.
• Know when to seek medical attention – if you cannot keep anything down, you have moderate to large ketones, your blood glucose is rising, or you have constant diarrhea.
• If in doubt, call your diabetes health professional or go to emergency.
• Talk to your diabetes health professional about developing a personal sick day management plan.

When looking for over-the-counter products (OTCs) to relieve symptoms, remember the following:

• Nutritional supplements, vitamins, alternative remedies such as herbals, botanicals, and homeopathic products are all considered OTCs. ‘Natural’ does not necessarily mean ‘safe,’ or that the product is free from possible drug interactions. Always ask your pharmacist whether an OTC can interact with existing medications or medical conditions.
• Many non-prescription medications contain more than one ingredient. It is best to choose a product that only contains ingredients specific to your symptoms. If in doubt, ask your pharmacist to recommend one.
• Do not assume that all products carrying the same name or brand contain the same ingredient. For instance:
  Chlor-Tripolon™ is chlorpheniramine, but Chlor-Tripolon ND™ is loratadine and pseudoephedrine.
  Sudafed™ is pseudoephedrine, but Sudafed PE™ is phenylephrine.
• If you have diabetes, be aware that some non-prescription medications, especially liquids, contain sugar. Look for sugar-free and alcohol-free alternatives, which are better choices.
• Those with other conditions, such as high blood pressure, kidney problems, or high cholesterol, should also look at the sodium, potassium, and fat content of any products. Again, ask your pharmacist if you are not sure.

Whenever you start any new prescription or OTC medication, whether for diabetes or another problem, it is important to monitor your blood glucose more closely. Additional monitoring allows you to know how the new medication is affecting you. Ideally, you should know your usual blood glucose values before you start a new medication. Once you have begun your new medication, do a similar testing pattern and compare your results. You and your health care provider are now able to see any effect the new medication has on your blood glucose levels. Each person reacts differently to medication and medication combinations.

Now, how can we help Mrs. Green decide what is right for her husband? The pharmacist will ask questions that can help decide if medication is necessary, and choose the right one.

• What are Mr. Green’s symptoms?
• How long has he been sick? Has he been able to eat or drink anything? Is he throwing up or does he have diarrhea?
• How well is his diabetes managed? What are his usual blood glucose levels like?
• How often does he test his blood glucose? What are his glucose readings like now?
• What types of medication is Mr. Green taking now, including prescription and non-prescription, and also herbals, vitamins, and/or supplements?
• Has Mr. Green tried any products already? How did they work? Did they affect his blood glucose?
• Does he have a sick day management plan?

By discussing these issues with the pharmacist, hopefully Mrs. Green will learn more about dealing with sickness and her husband’s diabetes. With help, she is able to make a wise choice for her husband. Knowledge, common sense, and increased monitoring of blood glucose goes a long way towards avoiding potential problems when self medicating. When in doubt, always ask your pharmacist!